Endocarditis Practice Questions

Question 1

What is the smallest left sided vegetation that can be detected with TTE on a native valve?

Answer 1

5mm

TEE = Gold Standard

Sensitivity TTE 0-25% for vegetations smaller than 5mm

Sensitivity TTE 84-100% for vegetations >10 mm

Overall sensitivities meta-analysis

TTE 62%

TEE 92%

Question 2

What is the smallest left sided vegetation that can be detected with TEE on a native valve?

Answer 2

1 mm diameter on TEE (High spatial resolution)

(remember: TTE is 5mm, TEE is 1mm)

Question 3

What is the typical acute phase vegetation defined as?

Answer 3

Discrete echoluncent mass adherent to the native valves or intracardiac prosthetic devices with high frequency motion independent of the underlying cardiac structure. The mass can be images in multiple views throughout the cardiac cycle.

Question 4

Where on the valve is endocarditis usually seen?

Answer 4

At or neara the lines of valve closure

Question 5

A definitive diagnosis of Infective endocarditis requires what?

Answer 5

1. 2 Major criteria
2. 1 minor criteria and 3 minor criteria
3. 5 minor criteriaa

Question 6

What does the Duke Criteria define a vegetation as?

Answer 6

Oscillaating intracaradiac mass on valves/supporting structures or in the path of regurgitant jets, or on implanted material, in the absence of an alternative anatomical explanation.

Question 7

Where do membranous VSD vegetations arise?

Answer 7

Septal Tricuspid Valve

Question 8

What % of Staph aureus bacteremia patient’s will have a missed endocarditis if only TTE performed (As compared to TEE)?

Answer 8

15%

Question 9

Where is the most common location of an abscess with infective endocarditis?

Answer 9

Aortic Root

Also found int he aorto-mitral intervalvular fibrosa

Question 10

What is the most common incorrect diagnosis if you saw a “mitral annular abscess” called on TTE?

Answer 10

Caseous Calcification of Mitral Annulus

Rule out –> Vegetation, Perforation of the leaflet, or valve dysfunction

Question 11

What is the best view of the Aortic Root Abscess?

Answer 11

ME SAX of AV

(Best location and extent of the root abscess)

Question 12

What is the best early sign of an aortic root abscess?

Answer 12

Thick aortic wall >10 mm

Serial echos can dilineate this

Cannot be ruled out in an AV or aortic root surgery